Recurrence of pulmonary emphysema in an alpha-1 proteinase inhibitor-deficient lung transplant recipient

Am J Respir Crit Care Med. 2004 Oct 1;170(7):811-4. doi: 10.1164/rccm.200312-1726CR. Epub 2004 Jun 7.


Several types of primary disease may recur after lung transplantation, but recurrence of pulmonary emphysema has so far never been published. We report the case of a 49-year-old white male who underwent single lung transplantation for emphysema related to alpha-1 antitrypsin deficiency and to superimposed smoking. The postoperative course was complicated by several rejection episodes. Subsequently, the patient remained stable without evidence of graft dysfunction for more than 10 years, but he resumed light smoking at 8 years after transplant. At 11 years after transplant, although the patient was still asymptomatic and had a stable lung function, recurrence of emphysema on the grafted side was diagnosed on computerized tomography of the thorax. One year later, the patient began to experience a moderate decline in lung function. Two separate bronchoalveolar lavages performed after the onset of the recurrence disclosed a significant elastolytic activity related to neutrophil serine-elastase in lavage fluid. In summary, we describe a case of recurrence of pulmonary emphysema in a patient with alpha-1 antitrypsin deficiency. The resumption of smoking has probably played a central role in the presence of elastolytic activity in lavage fluid and in the recurrence of emphysema.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Anti-Inflammatory Agents / therapeutic use
  • Bronchoalveolar Lavage Fluid / chemistry
  • Dyspnea / etiology
  • Forced Expiratory Volume
  • Graft Rejection / drug therapy
  • Graft Rejection / etiology
  • Humans
  • Leukocyte Elastase / analysis
  • Leukocyte Elastase / blood
  • Lung Transplantation*
  • Male
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Pulmonary Diffusing Capacity
  • Pulmonary Emphysema / diagnosis
  • Pulmonary Emphysema / etiology*
  • Pulmonary Emphysema / metabolism
  • Pulmonary Emphysema / surgery*
  • Recurrence
  • Risk Factors
  • Smoking / adverse effects*
  • Tomography, X-Ray Computed
  • Vital Capacity
  • alpha 1-Antitrypsin Deficiency / complications*
  • alpha 1-Antitrypsin Deficiency / drug therapy


  • Anti-Inflammatory Agents
  • Leukocyte Elastase
  • Methylprednisolone